Free MEDSURG-BC Cheat Sheet 2026: Exam Quick Reference

Assessment and Diagnosis

39%of exam

Health historyPhysical assessmentPsychosocial assessmentDiagnosticsFluids and electrolytes

Planning, Implementation, and Evaluation

40%of exam

Care planningPostoperative carePatient teachingMedication safetyHealth promotion

Professional Role

21%of exam

Therapeutic communicationTeam collaborationNursing ethicsEvidence-based practiceDelegation

Quick Facts

Credential: MEDSURG-BC
Total questions: 150
Scored questions: 125
Pretest questions: 25 unscored
Exam time: 3 hours
Passing score: 350 scaled
Testing vendor: Prometric
Testing window: 120 days
Credential term: 5 years
Current fees: $295 ANA | $395 nonmember

BE-FAST Stroke Screen

Balance, Eyes, Face, Arm, Speech, Time

Balance changeEye changeFacial droopArm weaknessSpeech changeTime critical

Fluid Overload vs Deficit

Overload

Weight gain
Crackles and edema
JVD may appear

Deficit

Weight loss
Tachycardia and hypotension
Low urine output

Trend weight and perfusion

Priority Question Ladder

Unresponsive and pulseless→Start CPR(Activate emergency response)
Airway threat present→Protect airway first(Airway outranks comfort)
Breathing acutely impaired→Support ventilation(Assess oxygenation)
Circulation unstable→Restore perfusion(Escalate immediately)
Acute neurologic change→Rapid focused assessment(Activate pathway)
No immediate threat→Assess before intervening(Use nursing process)
Multiple stable needs→Actual before risk(Acute before chronic)

Core Assessment Sequence

Primary survey: Airway, breathing, circulation
Standard exam: Inspect, palpate, percuss, auscultate
Abdominal exam: Inspect, auscultate, percuss, palpate
Pain history: Use PQRST or OLDCARTS
Medication reconciliation: Include OTC and supplements
Allergy record: Document specific reaction
Neurologic trend: Level of consciousness first
Fluid trend: Daily weight most reliable
Patient teaching: Assess readiness before teaching

Hyperkalemia vs Hypokalemia

Hyperkalemia

Peaked T waves
Widened QRS
Weakness may occur

Hypokalemia

Flattened T waves
U waves
Digoxin risk rises

Both threaten cardiac rhythm

Fluid and Electrolyte Patterns

Sodium: 135-145 mEq/L
Potassium: 3.5-5.0 mEq/L
ABG pH: 7.35-7.45
PaCO2: 35-45 mmHg
Bicarbonate: 22-26 mEq/L
Hyperkalemia: Peaked T; widening QRS
Hypokalemia: Flat T; U waves
Hypocalcemia: Tetany; Chvostek; Trousseau
Volume overload: Crackles, edema, JVD, weight gain
Volume deficit: Tachycardia, hypotension, low urine

DKA vs HHS

DKA

Ketosis prominent
Metabolic acidosis
Often faster onset

HHS

Hyperosmolality prominent
Minimal ketosis
Profound dehydration

Fluids precede insulin

Cardiopulmonary Patterns

Acute coronary syndrome: Ischemic symptoms need rapid ECG
Troponin: Trend myocardial injury
Left heart failure: Dyspnea, crackles, orthopnea
Right heart failure: JVD, edema, hepatomegaly
Peripheral arterial disease: Claudication, coolness, weak pulses
Venous insufficiency: Edema, warmth, stasis changes
Pulmonary embolism: Sudden dyspnea, pleuritic pain
Pneumothorax: Unilateral diminished breath sounds
Asthma danger: Silent chest signals obstruction
Tension pneumothorax: Hypotension, deviation, severe distress

Arterial vs Venous Disease

Arterial

Cool pale limb
Weak pulses
Dependent positioning helps

Venous

Warm edematous limb
Stasis changes
Elevation may help

Perfusion versus return failure

Neurologic and Endocrine Patterns

Acute stroke: BE-FAST; establish last-known-well
Delirium: Acute, fluctuating, inattentive
Dementia: Chronic, progressive decline
GCS: Eye, verbal, motor responses
DKA: Hyperglycemia, ketosis, metabolic acidosis
HHS: Hyperglycemia, hyperosmolality, minimal ketosis
Thyroid storm: Fever, tachycardia, agitation
Myxedema coma: Hypothermia, bradycardia, hypoventilation
SIADH: Hyponatremia, concentrated urine
Diabetes insipidus: Polyuria, dilute urine, hypernatremia

Delirium vs Dementia

Delirium

Acute onset
Fluctuating attention
Usually reversible cause

Dementia

Gradual onset
Progressive decline
Attention preserved early

Acute fluctuation signals delirium

GI, Renal, and Hematology Patterns

Upper GI bleeding: Hematemesis or melena
Lower GI bleeding: Usually hematochezia
Pancreatitis: Epigastric pain; elevated lipase
Bowel obstruction: Distention, vomiting, altered sounds
Prerenal AKI: Renal hypoperfusion
Intrarenal AKI: Direct kidney injury
Postrenal AKI: Urinary outflow obstruction
Nephritic pattern: Hematuria, hypertension, mild proteinuria
Nephrotic pattern: Heavy proteinuria, edema, hypoalbuminemia
DIC: Systemic coagulation and bleeding

Diagnostic Danger Signals

Rising troponin: Escalate suspected myocardial injury
ANC below 500: Severe neutropenia
Lactate trend: Tracks tissue hypoperfusion
Creatinine trend: Tracks renal function change
Falling platelets: Assess bleeding and HIT
Sudden hemoglobin drop: Assess active bleeding
New ST elevation: Activate emergency cardiac pathway
New focal deficit: Activate stroke pathway
Pain with passive stretch: Suspect compartment syndrome

AEIOU Dialysis Indications

Acidosis, Electrolytes, Intoxication, Overload, Uremia

Refractory acidosisDangerous electrolytesDialyzable toxinsRefractory overloadUremic complications

Contact vs Droplet Precautions

Contact

Gown and gloves
Contaminated surfaces matter
Examples: C. difficile, MRSA

Droplet

Surgical mask
Close respiratory spread
Examples: influenza, meningococcus

Match PPE to transmission

Clinical Escalation Actions

Transfusion reaction suspected→Stop transfusion(Keep IV with saline)
Hyperkalemic ECG changes→Cardiac monitoring immediately(Anticipate IV calcium)
Conscious hypoglycemia→Give 15g carbohydrate(Recheck after 15 minutes)
Unconscious hypoglycemia→Dextrose or glucagon(Protect airway)
Stroke signs appear→Activate stroke pathway(Document last-known-well)
Sepsis with hypoperfusion→Execute sepsis protocol(Time-sensitive treatment)
Opioid sedation worsens→Support ventilation(Prepare naloxone)

Emergency First Actions

Transfusion reaction: Stop transfusion immediately
Anaphylaxis: Give IM epinephrine
Seizure: Protect airway; time event
Evisceration: Cover with moist sterile dressing
Autonomic dysreflexia: Sit upright; remove trigger
Hyperkalemic ECG changes: Anticipate IV calcium
Opioid respiratory depression: Ventilate and give naloxone
Hypoglycemia, conscious: Give 15g fast carbohydrate
Suspected stroke: Check glucose; activate pathway
Pulseless arrest: Start CPR; activate code

ADPIE Nursing Process

Assess, Diagnose, Plan, Implement, Evaluate

Assess firstName problemSet outcomesPerform careReassess results

Palliative vs Hospice Care

Palliative

Any serious illness stage
May accompany curative care
Symptom relief focus

Hospice

Comfort-focused care
Terminal prognosis criteria
May occur across settings

Both prioritize quality of life

Isolation Precaution Picker

Every patient encounter→Standard precautions(Risk-based PPE)
C. difficile diarrhea→Contact precautions(Soap-and-water handwashing)
Draining MRSA wound→Contact precautions(Gown and gloves)
Influenza suspected→Droplet precautions(Wear surgical mask)
Pulmonary TB suspected→Airborne precautions(N95 and negative pressure)
Varicella suspected→Airborne plus contact(Follow facility policy)

Medication Safety and Reversals

Unfractionated heparin: Monitor aPTT or anti-Xa
Heparin reversal: Protamine sulfate
Warfarin monitoring: Use INR
Warfarin reversal: Vitamin K; PCC if severe
Opioid reversal: Naloxone; monitor re-sedation
Digoxin reversal: Digoxin immune Fab
Acetaminophen reversal: N-acetylcysteine
Magnesium toxicity: Stop magnesium; give calcium
IV potassium: Never administer IV push
PCA safety: Only patient presses button

Infection Prevention and Precautions

Standard precautions: Apply to every patient
Contact precautions: Gown and gloves
Droplet precautions: Wear surgical mask
Airborne precautions: N95; negative-pressure room
C. difficile: Contact plus soap-and-water
CAUTI prevention: Remove catheter early
CLABSI prevention: Scrub hub; assess necessity
VAP prevention: Elevate head; oral care
Needlestick: Wash, report, seek evaluation
Neutropenic fever: Culture and escalate urgently

Teaching and Discharge Essentials

Teach-back: Patient explains instructions
Return demonstration: Verifies psychomotor learning
Heart failure: Daily same-scale weights
Warfarin: Keep vitamin K consistent
Diabetes sick-day: Continue insulin; monitor frequently
Limited English: Use qualified interpreter
Inhaler technique: Demonstrate and verify technique
Postoperative lungs: Cough, deep breathe, ambulate
Discharge planning: Begin at admission
Readiness to learn: Address pain and anxiety

Wounds, Mobility, and Postoperative Care

Stage 1 pressure injury: Nonblanchable intact skin
Stage 2 pressure injury: Partial-thickness skin loss
Stage 3 pressure injury: Full-thickness; fat visible
Stage 4 pressure injury: Exposed deep structures
Unstageable injury: Base obscured by tissue
Posterior hip precautions: Avoid flexion, adduction, rotation
Cane use: Hold on strong side
Suspected DVT: Do not massage limb
Early ambulation: Prevents multiple postoperative complications

SBAR Communication

Situation, Background, Assessment, Recommendation

Current problemRelevant historyClinical interpretationRequested action

Stable vs Unstable Assignment

Stable

Predictable course
Routine established care
May suit LPN/LVN

Unstable

Changing condition
Frequent reassessment
Requires RN judgment

Instability stays with RN

Delegation Assignment Picker

New or unstable patient→Assign RN(Needs clinical judgment)
Initial assessment needed→Assign RN(Never delegate assessment)
New teaching needed→Assign RN(Reinforcement may vary)
Stable predictable care→Consider LPN/LVN(Follow local scope)
Routine ADL task→Consider UAP(Give clear directions)
Abnormal result reported→RN assesses(RN evaluates response)

Delegation and Supervision

RN retains: Assessment and clinical judgment
RN teaching: Initial education stays RN
RN evaluation: Outcome evaluation stays RN
LPN/LVN: Stable predictable assignments
UAP: Routine standardized tasks
Abnormal findings: RN evaluates promptly
Delegation accountability: RN remains accountable
Five rights: Task, circumstance, person, direction, supervision
Scope limits: Follow law and policy

PICO Evidence Question

Population, Intervention, Comparison, Outcome

Target populationPlanned interventionComparison optionDesired outcome

EBP vs Quality Improvement

EBP

Applies best evidence
Includes patient preferences
Answers clinical questions

QI

Improves local process
Uses local data
Tests workflow changes

Evidence guides; QI improves

Communication and Legal Duties

SBAR: Situation, background, assessment, recommendation
CUS: Concerned, uncomfortable, safety issue
Informed consent: Provider explains; nurse witnesses
Treatment refusal: Competent adult may refuse
Confidentiality: Use minimum necessary information
Documentation: Objective, timely, factual
Incident report: Quality record, not charted
Advance directive: Records future care wishes
POLST: Portable medical orders
Chain of command: Escalate unresolved safety concerns

Five Delegation Rights

Task, Circumstance, Person, Direction, Supervision

Right taskRight circumstanceRight personRight directionsRight supervision

Ethics, Evidence, and Quality

Autonomy: Respect informed choices
Beneficence: Promote patient good
Nonmaleficence: Avoid preventable harm
Justice: Distribute care fairly
Veracity: Tell the truth
Fidelity: Keep professional commitments
PICO: Frames searchable clinical question
PDSA: Tests small process changes
Root cause analysis: Retrospective event review
FMEA: Prospective risk analysis
Just culture: Balances learning and accountability

Common Traps

Pretest Items Look Identical

Twenty-five items are unscored ≠ Answer every question

Scaled Score Is Not Percentage

Passing score is 350 ≠ Raw score gets converted

Assess Before Acting

Use nursing process ≠ Emergencies are exceptions

Stop Blood Before Calling

Stop suspected reaction first ≠ Then notify and investigate

Alcohol Rub Misses Spores

C. difficile needs soap ≠ Use contact precautions

Potassium Is Never IV Push

Dilute before infusion ≠ Use controlled pump rate

Delegation Keeps Accountability

RN chooses appropriate task ≠ RN evaluates outcomes

Nurse Does Not Obtain Consent

Provider explains procedure ≠ Nurse witnesses signature

PCA Means Patient Only

No family proxy dosing ≠ Monitor sedation closely

Last Minute

1.Know 39-40-21 domain weights
2.Answer all 150 questions
3.Use ABCs before comfort
4.Assess unless immediate danger
5.Trend labs, not snapshots
6.Recognize potassium ECG changes
7.Stop suspected transfusion reactions
8.Never IV-push potassium
9.Check glucose during neuro changes
10.Match isolation to transmission
11.Use teach-back before discharge
12.Keep unstable patients with RN
13.Escalate unresolved safety concerns
14.Separate EBP from QI
15.Reassess every intervention

ANCC-MEDSURG-BC

Practice Questions200 questions Study Guide Cheat Sheet Flashcards50 cards 2 videos 3 blogs

Med Surg Certification Study Guide: MedSurg BC Review Book + 500 Practice Questions for the ANCC Medical-Surgical Nursing Certification Exam | Med Surg Nursing Book (Includes 4 Full-Length Tests)

$27.99 · Buy on Amazon

Practice exams on ExamEdge

Flashcards on Mometrix

Same family resources

Explore More ANCC Nursing Certifications

Continue into nearby exams from the same family. Each card keeps practice questions, study guides, flashcards, videos, and articles in one place.

More From This Family

Videos and articles for deeper review.

VideoCMSRN vs MEDSURG-BC 2026: Which Med-Surg Cert? (FREE Guide)This exam VideoFREE Med-Surg Nursing Certification Study Guide 2026: 8-Week MEDSURG-BC PlanThis exam VideoANCC AGACNP-BC Exam Guide 2026: Acute Care NP Prep VideoFREE ANCC FNP Study Guide 2026: FNP-BC Blueprint, Pass Rate, and 12-Week Plan ArticleCMSRN vs MEDSURG-BC 2026: Which Med-Surg Cert? (FREE Guide)15 min read ArticleFREE Med-Surg Nursing Certification Study Guide 2026: 8-Week MEDSURG-BC Plan14 min read ArticleFREE ANCC MEDSURG-BC Exam Guide 2026: Format, Eligibility, Study Plan13 min read ArticleFREE ANCC NPD-BC Exam Guide 2026: Nursing Professional Development16 min read

ANCC MEDSURG-BC Cheat Sheet